Expanding Connecticut’s ADAP in a Reformed

Health SystemBy

Deborah GosselinNurse Consultant

Rebate Model Eligibility: Connecticut Resident,

Documentation of HIV positive status, & Income 400% FPL or less

Connecticut Insurance Premium Assistance Program

Connecticut AIDS Drug Assistance Program (CADAP)

Year Enrolled Clients

New Clients Clients with Insurance

6/2014 1,939 16 1,259

6/2013 2,155 18 1,117

6/2012 2,136 37 1,127

0

3,000

6,000

9,000

12,000

15,000

12,563

10,849

7,321

5,605 5,768Nu

mb

er

15.8% unaware

33% not in care(no report of VL or CD4)

currently living in Connecticut

HIV continuum of care, Connecticut, 2012(data reported through 2013)

The overall population is overestimated because at time of report cases were only followed up for 11 months after 12/31/2012. CDC suggests that every case should be followed up at least 18 months to collect death certificate information.

Goal: Develop & coordinate state & local strategies to identify

people who are unaware of their HIV positive status, refer, and link them to medical care and support services

Target Populations: MSMs: 24% of Connecticut PLWH (2011 data) Black Heterosexuals: 32% of CT PLWH Hispanic Heterosexuals: 32% of CT PLWH

Individuals termed “Unaware” Not been tested in past 12 months Not informed of HIV test result (+ or -) Not been informed of their confirmatory test result

Early Identification of Individuals with HIV/AIDS (EIIHA)

Fund 2 ProgramsCollaborate services with MAI, OTL, MCMs,

PS, Prevention Programs, Medical Providers, Community Based Organizations, etc.

Outreach & EducationSoup kitchens, homeless shelters, adult bookstores, know drug trafficking sites, MSM cruising sites, package stores, minority based cafes, housing complexes, youth service centers, faith based organization, etc.

Early Intervention Services (EIS)

Develop “street relationships” to identify potential clients and gate keepers

Develop key points of entry to access sex workers, MSM “party” groups, IDU and homeless individuals not residing in shelters

Provide referrals for HIV C&T, prevention services if HIV negative; medical case management (MCM), medical care, health insurance, CADAP, etc. if HIV positive

Can provide HIV C&T if no other HIV C&T services are available

EIS Continued

MCMs collaborate with EIS to locate and re-engage clients who have fallen out of care and/or MCM

Provide education & counseling for newly diagnosed HIV positive individuals

Accompany client to first medical appointment refer client to PS, etc.

Provide HIV information and promote HIV testing at targeted community events

Provide follow-up for 3-6 months to ensure clients remain engaged in care

EIS Continued

2013-2014 Outcomes Individuals referred to C&T: 369 (8 HIV

Positive)Out-of -Care individuals returned to care: 50New to Care clients: 15

Case Study

EIS continued

One program located in Hartford County

Focus is to identify and facilitate entry or re-entry in to care for minority HIV positive individuals and to connect eligible clients with CADAP

CADAP (Average April-June 2014) White: 1,392 Hispanic: included in White Black: 852 Asian: 21 Native American: 11 Pacific Islander: 2

Clients referred to CADAP: 4

Minority AIDS Intervention (MAI)

Bi-lingual/Bi-cultural staff

Targeted Outreach Education at shelters, soup kitchens, drop-in-centers, City of Hartford Health Van, streets, etc.

Targeted Community Education

Provide HIV Testing when other testing programs are not available

Assist in locating and re-connecting minority PLWH who are lost-to-care

MCMs referred 30 out-of-care clients to CAHEC & all clients were located & re-connected to care (2012)

Collaborate with other Ryan White providers, PS, MCMs, community Organizations

Minority AIDS Intervention (MAI)

8 Statewide programs (Currently 260 active clients)

Eligibility: Connecticut resident, documentation of HIV positive status, income of 300% FPL or less, and contemplating or taking HIV medications

Collaboration with client’s Medical Provider & MCM encouraged

Medical/psychosocial model staffed by Nurses

Services are provided in a medical and/or community based settings

Medication Adherence Program (MAP)

Provide an assessment of client’s motivation, strengths, & weakness for medication adherence and understanding of HIV disease

Assess the clients psychosocial situation, identify any barriers to adherence, and develop strategies with the client to overcome the barriers

Develop an individualized Care Plan

Provide HIV disease & treatment education and Adherence Tools

MAP Continued